Irritant contact eczema

Irritant contact eczema (or dermatitis) is far more common than allergic contact eczema. It's the second most common cause of occupational-related health problems, after muscle and joint pains and injuries.

Almost all occupations in which skin (usually the hands) is made wet repeatedly are associated with irritant contact dermatitis. Hairdressers, cleaners, catering workers, food processors and fish handlers are occupations where water is the wetting agent.

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Prolonged contact with water swells the surface cells of the skin and disrupts the normally tight joins between them, exposing the more vulnerable deeper layers.

In metal engineering, light machine oils are commonly in contact with the skin, and as many as half of workers in this industry have irritant contact eczema. Many just accept it as part of the job.

Having one type of eczema can increase the risk of another, so people with a background history of atopic eczema are particularly prone to developing the irritant contact type.

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It's not just the industrial environment in which skin-unfriendly agents can be found. Many household items such as cleaning materials, detergents and bleach are just as potentially harmful.

Hobby interests or a passion for DIY can lead to frequent skin contact with adhesives, paint, oils and cement.

Diagnosis

Irritant contact eczema looks the same as other types of eczema.

The connection with the work environment may be obvious if there is routine contact with a known irritant or the job is a 'wet work' type. Otherwise, it may take time to establish that the skin is reacting against an irritant.

Therefore irritant contact eczema is dependent for diagnosis on a good history of work exposure and knowledge of likely problem agents.

Also, a negative patch test result can be useful to exclude an allergic contact dermatitis.

Treatment

Removal from contact with the offending substance should be the ideal, but this is often impractical.

In these circumstances, however, the aims of treatment can only be to reduce symptoms. Unfortunately, some irritants cause skin reaction even with little exposure.

Where contact is inevitable, protective gloves are essential.

Since the latex or rubber in gloves can cause or worsen eczema, some people find it helpful to use cotton-lined gloves or separate cotton inner gloves to reduce the degree of direct skin contact.

Soap substitutes are moisturisers that can also clean the hands. They can reduce the irritant effect of washing with normal soap.

Barrier creams can be of some benefit, but they may be counter-productive if they encourage workers to take less care, thinking the barrier cream alone protects them.

Anti-inflammatory (steroid) creams are the mainstay of irritant eczema treatment.

Employment issues

Employers have a duty to protect their workers against occupational hazard. Similarly, workers have a duty to make use of the protection measures offered by their employer.

As with any eczema, the cause and effect relationship between the agent and the skin reaction is easier to explain than to detect.

Many cases of irritant contact eczema could be completely avoided by the use of simple avoidance and control measures.

Larger companies in known high-risk areas of employment will probably make use of an occupational health doctor or nurse who can evaluate the problem and advise on corrective measures. Most workers are not so lucky.

Compensation issues can arise where the employer fails to provide sufficient protective measures or warnings about the possibility of eczema arising.

However, proving such cases is a lengthy and expensive process that is not usually successful.

It's much better to be aware of the possibility of a link between skin reactions and your occupation and to take as many practical steps as possible to avoid running into trouble.

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.